Surgical instruments and methods for performing tonsillectomy and adenoidectomy procedures

ABSTRACT

A method of surgery utilizing an end effector assembly having first and second jaw members defining a grasping area therebetween and a tissue-treating area therebetween. Each of the first and second jaw members defines a knife channel positioned within the grasping area and outside of the tissue-treating area. The end effector assembly is positioned such that the knife channels are positioned adjacent tissue to be removed. Thereafter, the first and/or second jaw members are moved from a spaced-apart position to an approximated position to grasp tissue therebetween, the jaw members are energized for conducting energy through tissue disposed within the tissue-treating area to treat tissue disposed within the tissue-treating area, and a knife is advanced through the knife channels to cut tissue adjacent the tissue-treating area thereby separating tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of, and priority to, U.S.Provisional Patent Application Nos. 62/035,775 and 62/035,792, both ofwhich were filed on Aug. 11, 2014. This application is related to U.S.patent application Ser. No. ______, filed on ______. The entire contentsof each of the above applications are hereby incorporated herein byreference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical instruments and methods and,more particularly, to surgical instruments and methods for performingtonsillectomy and/or adenoidectomy procedures.

2. Background of Related Art

The tonsils and adenoids are part of the lymphatic system and aregenerally located in the back of the throat. These parts of thelymphatic system are generally used for sampling bacteria and virusesentering the body and activating the immune system when warranted toproduce antibodies to fight oncoming infections. More particularly, thetonsils and adenoids break down the bacteria or virus and send pieces ofthe bacteria or virus to the immune system to produce antibodies forfighting off infections.

Inflammation of the tonsils and adenoids (e.g., tonsillitis) impedes theability of the tonsils and adenoids to destroy the bacteria resulting ina bacterial infection. In many instances, the bacteria remain even aftertreatment and serve as a reservoir for repeated infections (e.g.,tonsillitis or ear infections).

A tonsillectomy and/or adenoidectomy may be performed when infectionspersist and antibiotic treatments fail. Persistent infection typicallyleads to enlarged tonsil tissue which may need to be removed since inmany cases the enlarged tissue causes airway obstruction leading tovarious sleep disorders such as snoring or, in some cases, sleep apnea.Some individuals are also born with larger tonsils that are more proneto cause obstruction. An adenoidectomy may also be required to removeadenoid tissue when ear pain persists, or when nose breathing orfunction of the Eustachian tube is impaired. Often times, tonsillectomyand adenoidectomy procedures are performed at the same time.

SUMMARY

As used herein, the term “distal” refers to the portion that is beingdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, to the extent consistent, any of the aspects described hereinmay be used in conjunction with any or all of the other aspectsdescribed herein.

A method of surgery provided in accordance with the present disclosureincludes utilizing an end effector assembly including first and secondjaw members, each jaw member having an opposed surface. The opposedsurfaces define a grasping area therebetween. The jaw members eachfurther include tissue-treating plates disposed thereon. Thetissue-treating plates define a tissue-treating area therebetween. Eachof the first and second jaw members defines a knife channel positionedwithin the grasping area and outside of the tissue-treating area. Themethod further includes positioning the end effector assembly relativeto tissue such that the knife channels are positioned adjacent tissue tobe removed; moving the jaw members to an approximated position to grasptissue therebetween; energizing the first and second plates to differentpotentials for conducting energy through tissue disposed within thetissue-treating area to treat tissue disposed within the tissue-treatingarea; and advancing a knife at least partially through the knifechannels to cut tissue adjacent the tissue-treating area therebyseparating tissue.

In an aspect of the present disclosure, the method further includesremoving the separated tissue.

In another aspect of the present disclosure, conducting energy throughtissue disposed within the tissue-treating area includes conductingenergy in a generally parallel orientation relative to the opposedsurfaces of the first and second jaw members. Alternatively, energy maybe conducted in a generally perpendicular orientation.

In yet another aspect of the present disclosure, one or both of the jawmembers includes a dam positioned outside the tissue-treating area on anopposite side thereof relative to the knife channels. In such aspects,positioning the end effector assembly includes positioning the damadjacent tissue to remain and, during the conducting of energy betweenthe tissue-treating plates, the dam inhibits energy, e.g., thermaland/or electrical energy, from being conducted outside thetissue-treating area towards tissue to remain.

Another method of surgery provided in accordance with the presentdisclosure includes positioning an end effector assembly relative totissue such that tissue is disposed between first and second jaw membersof the end effector assembly. The first and second jaw members haveopposed surfaces that define a tissue-grasping area therebetween and atissue-treating area therebetween. The tissue-treating area is disposedwithin the tissue-grasping area. The method further includes moving atleast one of the first and second jaw members relative to the other froma spaced-apart position to an approximated position to grasp tissuewithin the tissue-grasping area, energizing at least one of the firstand second jaw members for conducting energy through tissue disposedwithin the tissue-treating area to treat tissue disposed within thetissue-treating area, and advancing a knife at least partially throughtissue grasped within the tissue-grasping but outside thetissue-treating area to cut tissue adjacent the tissue-treating areathereby separating tissue.

In an aspect of the present disclosure, the method further includesremoving the separated tissue.

In another aspect of the present disclosure, conducting energy throughtissue disposed within the tissue-treating area includes conductingenergy in a generally parallel orientation relative to the opposedsurfaces of the first and second jaw members.

In yet another aspect of the present disclosure, conducting energythrough tissue disposed within the tissue-treating area includesconducting energy in a generally perpendicular orientation relative tothe opposed surfaces of the first and second jaw members.

In still another aspect of the present disclosure, at least one of thejaw members includes a dam positioned outside the tissue-treating area.In such aspects, positioning the end effector assembly includespositioning the dam adjacent tissue to remain such that, during theconduction of energy through tissue disposed within the tissue-treatingarea, the dam inhibits energy from being conducted outside thetissue-treating area towards tissue to remain.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedherein with reference to the drawings wherein:

FIG. 1 is a front, side, perspective view of an endoscopic surgicalforceps configured for use in accordance with the present disclosure;

FIG. 2 is a front, side, perspective view of an open surgical forcepsconfigured for use in accordance with the present disclosure;

FIG. 3A is a side, cut-away view of the proximal portion of the surgicalforceps of FIG. 1, wherein a portion of the housing and some of theinternal components thereof have been removed to unobstructivelyillustrate the handle, knife, and drive assemblies of the forceps;

FIG. 3B is a perspective, cut-away view of the distal portion of thesurgical forceps of FIG. 1, wherein the shaft has been removed toillustrate the drive bar, knife assembly, and end effector assembly ofthe forceps;

FIG. 4 is a transverse, cross-sectional view of the distal portion of anend effector assembly provided in accordance with the present disclosureand configured for use with the surgical forceps of FIGS. 1 and 2, orany other suitable surgical instrument;

FIG. 5 is a transverse, cross-sectional view of another end effectorassembly provided in accordance with the present disclosure andconfigured for use with the surgical forceps of FIGS. 1 and 2, or anyother suitable surgical instrument;

FIG. 6 is a transverse, cross-sectional view of still another endeffector assembly provided in accordance with the present disclosure andconfigured for use with the surgical forceps of FIGS. 1 and 2, or anyother suitable surgical instrument;

FIG. 7 is a transverse, cross-sectional view of yet another end effectorassembly provided in accordance with the present disclosure andconfigured for use with the surgical forceps of FIGS. 1 and 2, or anyother suitable surgical instrument; and

FIG. 8 is a transverse, cross-sectional view of still yet another endeffector assembly provided in accordance with the present disclosure andconfigured for use with the surgical forceps of FIGS. 1 and 2, or anyother suitable surgical instrument.

DETAILED DESCRIPTION

Turning to FIGS. 1 and 2, FIG. 1 depicts a handheld, shaft-basedsurgical forceps 10 and FIG. 2 depicts a hemostat-style forceps 10′. Forthe purposes herein, either forceps 10, forceps 10′, or any othersuitable surgical instrument may be utilized in accordance with thepresent disclosure. Obviously, different electrical and mechanicalconnections and considerations apply to each particular type ofinstrument; however, the aspects and features of the present disclosureremain generally consistent regardless of the particular instrumentused.

Referring to FIG. 1, forceps 10 generally includes a housing 20, ahandle assembly 30, a trigger assembly 60, a rotating assembly 70, anactivation switch 4, and an end effector assembly 100. Forceps 10further includes a shaft 12 having a distal end 14 configured tomechanically engage end effector assembly 100 and a proximal end 16 thatmechanically engages housing 20. Forceps 10 also includes cable 2 thatconnects forceps 10 to an energy source (not shown), e.g., a generatoror other suitable power source, although forceps 10 may alternatively beconfigured as a battery-powered device. Cable 2 includes a wire (orwires) (not shown) extending therethrough that has sufficient length toextend through shaft 12 in order to provide energy to one or bothtissue-treating plates 114, 124 (FIG. 3B) of jaw members 110, 120,respectively. Activation switch 4 is coupled to tissue-treating plates114, 124 (FIG. 3B) of jaw members 110, 120, respectively, and the sourceof energy for selectively activating the supply of energy to jaw members110, 120 for treating, e.g., cauterizing, coagulating/desiccating,and/or sealing, tissue.

With additional reference to FIGS. 3A and 3B, handle assembly 30includes fixed handle 50 and a movable handle 40. Fixed handle 50 isintegrally associated with housing 20 and handle 40 is movable relativeto fixed handle 50. Movable handle 40 of handle assembly 30 is operablycoupled to a drive assembly 140 that, together, mechanically cooperateto impart movement of one or both of jaw members 110, 120 about a pivot103 between a spaced-apart position and an approximated position tograsp tissue between jaw members 110, 120. In particular, movable handle40 is coupled to drive bar 142 via a drive mandrel 144 such thatmovement of movable handle 40 relative to housing 20 effectslongitudinal translation of drive bar 142 through housing 20 and shaft12. The distal end of drive bar 142 is coupled to one or both jawmembers 110, 120 such that longitudinal translation of drive bar 142relative to end effector assembly 100 pivots one or both of jaw members110, 120 relative to one another. As shown in FIG. 1, movable handle 40is initially spaced-apart from fixed handle 50 and, correspondingly, jawmembers 110, 120 are disposed in the spaced-apart position. Movablehandle 40 is depressible from this initial position to a depressedposition corresponding to the approximated position of jaw members 110,120. Further, a biasing member 146 may be disposed within housing 20 andpositioned to bias drive bar 142 distally, thereby biasing jaw members110, 120 towards the spaced-apart position. However, otherconfigurations are also contemplated.

Trigger assembly 60 includes a trigger 62 coupled to housing 20 andmovable relative thereto between an un-actuated position and an actuatedposition for deploying a knife 162 of a knife assembly 160 from aretracted position, wherein knife 162 is positioned proximally of endeffector assembly 100, and an extended position, wherein knife 162extends at least partially between jaw members 110, 120 to cut tissuegrasped therebetween. More specifically, trigger 62 is operably coupledto a knife drive bar 161 via a knife drive mandrel 164 such thatmovement of trigger 62 relative to housing 20 effects longitudinaltranslation of knife drive bar 161 through housing 20 and shaft 12. Thedistal end of knife drive bar 161 is coupled to knife 162 such thatlongitudinal translation of knife drive bar 161 effects translation ofknife 162 relative to end effector assembly 100. Trigger 62, as shown inFIG. 1, is initially disposed in the un-actuated position and,correspondingly, knife 162 is disposed in the retracted position.Trigger 62 is selectively actuatable from this un-actuated position toan actuated position corresponding to the extended position of knife162. Further, a biasing member 166 may be disposed within housing 20 andpositioned to bias knife drive bar 161 proximally, thereby biasing knife162 towards the retracted position and trigger 62 towards theun-actuated position.

Referring to FIG. 2, forceps 10′ is shown including two elongated shaftmembers 12 a, 12 b, each having a proximal end 16 a, 16 b, and a distalend 14 a, 14 b, respectively. Forceps 10′ is configured for use with anend effector assembly 100′ similar to end effector assembly 100 (FIGS. 1and 3B). More specifically, end effector assembly 100′ includes firstand second jaw members 110′, 120′ attached to respective distal ends 14a, 14 b of shaft members 12 a, 12 b. Jaw members 110′, 120′ arepivotably connected about a pivot 103′. Each shaft member 12 a, 12 bincludes a handle 17 a, 17 b disposed at the proximal end 16 a, 16 bthereof. Each handle 17 a, 17 b defines a finger hole 18 a, 18 btherethrough for receiving a finger of the user. As can be appreciated,finger holes 18 a, 18 b facilitate movement of the shaft members 12 a,12 b relative to one another to, in turn, pivot jaw members 110′, 120′from the spaced-apart position, wherein jaw members 110′, 120′ aredisposed in spaced relation relative to one another, to the approximatedposition, wherein jaw members 110′, 120′ cooperate to grasp tissuetherebetween.

One of the shaft members 12 a, 12 b of forceps 10′, e.g., shaft member12 a, includes a proximal shaft connector 19 configured to connect theforceps 10′ to a source of energy (not shown), e.g., a generator.Proximal shaft connector 19 secures a cable 2′ to forceps 10′ such thatthe user may selectively supply energy to jaw members 110′, 120′ fortreating tissue, and for energy-based tissue cutting. More specifically,an activation switch 4′ is provided for supplying energy to jaw members110′, 120′ to treat tissue upon sufficient approximation of shaftmembers 12 a, 12 b, e.g., upon activation of activation switch 4′ viashaft member 12 b.

Forceps 10′ further includes a trigger assembly 60′ including a trigger62′ coupled to one of the shaft members, e.g., shaft member 12 b, andmovable relative thereto between an un-actuated position and an actuatedposition for deploying a knife (not shown, similar to knife 162 offorceps 10′ (FIG. 3B)) from a retracted position within one of the shaftmembers, e.g., shaft member 12 b, to an extended position between jawmembers 110′, 120′ for cutting tissue grasped between jaw members 110′,120′.

With reference to FIG. 3B, end effector assembly 100 of forceps 10(FIG. 1) is shown, although end effector assembly 100 may similarly beused in conjunction with forceps 10′ (FIG. 2), or any other suitablesurgical instrument. For purposes of simplicity, end effector assembly100 is described herein as configured for use with forceps 10 (FIG. 1).Further, end effector assembly 100 is generally described below withreference to FIG. 3B, followed by a detailed description, in conjunctionwith FIGS. 4-8, of various configurations of end effector assembliessuitable for use in performing tonsillectomy and/or adenoidectomyprocedures. Each of these configurations may incorporate the generalfeatures of end effector assembly 100 and may likewise be used withforceps 10 (FIG. 1), forceps 10′ (FIG. 2), or any other suitablesurgical instrument. The general features detailed with respect to endeffector assembly 100 (FIG. 3B), although applicable to the end effectorassemblies of FIGS. 4-8, will not be repeated for purposes of brevity.

Each jaw member 110, 120 of end effector assembly 100 includes a jawframe having a proximal flange portion 111, 121, an outer insulative jawhousing 112, 122 disposed about the distal portion (not explicitlyshown) of each jaw frame, and a tissue-treating plate 114, 124,respectively. Proximal flange portions 111, 121 are pivotably coupled toone another about pivot 103 for moving jaw members 110, 120 between thespaced-apart and approximated positions, although other suitableconfigurations for allowing the pivoting of jaw members 110, 120 arealso contemplated. The distal portions (not explicitly shown) of the jawframes are configured to support jaw housings 112, 122, andtissue-treating plates 114, 124, respectively, thereon.

Outer insulative jaw housings 112, 122 of jaw members 110, 120 supportand retain tissue-treating plates 114, 124 on respective jaw members110, 120 in opposed relation relative to one another. Tissue-treatingplates 114, 124 are formed from an electrically conductive material,e.g., for conducting electrical energy therebetween for treating tissue,although tissue-contacting plates 114, 124 may alternatively beconfigured to conduct any suitable energy, e.g., thermal, microwave,light, ultrasonic, etc., through tissue grasped therebetween forenergy-based tissue treatment. As mentioned above, tissue-treatingplates 114, 124 are coupled to activation switch 4 (FIG. 1) and thesource of energy (not shown), e.g., via the wires (not shown) extendingfrom cable 2 (FIG. 1) through forceps 10 (FIG. 1), such that energy maybe selectively supplied to tissue-treating plate 114 and/ortissue-treating plate 124 and conducted therebetween and through tissuedisposed between jaw members 110, 120 to treat tissue.

One or both of jaw members 110, 120 may further include a knife channel125 (FIG. 3B) defined therein and extending longitudinally therealong.Knife channel(s) 125 (FIG. 3B) are configured to receive a portion ofknife 162 (FIG. 3B) as knife 162 (FIG. 3B) is translated from theretracted position to the extended position to guide the translation ofknife 162 (FIG. 3B) between jaw members 110, 120.

Various different configurations of end effector assemblies, similar toend effector assembly 100 (FIG. 3B) are detailed below with respect toFIGS. 4-8. Each of these end effector assemblies is configured tofacilitate performing tonsillectomy and/or adenoidectomy procedures,although such end effector assemblies may similarly be beneficial foruse in a variety of other procedures. To the extent consistent, any ofthe features of any of these end effector assemblies may be used inconjunction with any or all of the other end effector assembliesdescribed herein.

Turning to FIG. 4, end effector assembly 200 includes first and secondjaw members 210, 220, respectively. One of the jaw members, e.g., jawmember 210 includes an insulative jaw housing 212 having a pair ofspaced-apart, electrically-conductive tissue-treating plates 214 a, 214b recessed or partially-recessed within jaw housing 212 to define aplanar tissue-grasping surface 216. Tissue-treating plates 214 a, 214 bare adapted to connect to a source of energy. More specifically, endeffector assembly 200 may define a bipolar configuration, wherein plate214 a is charged to a first electrical potential and plate 214 b ischarged to a second, different electrical potential such that anelectrical potential gradient is created for conducting energy betweenplates 214 a, 214 b and through tissue grasped between jaw members 210,220 for treating, e.g., sealing, tissue. In this configuration, energyis conducted between tissue-treating plates 214 a, 214 b transversely,that is, in a generally parallel direction relative to the plane definedby tissue-grasping surface 216. Further, in this configuration, thetissue-treatment area is defined between tissue-treating plates 214 a,214 b. In other words, energy conduction through tissue is substantiallyconfined to the tissue disposed within the peripheral bounds oftissue-treating plates 214 a, 214 b and, thus only such tissue istreated.

A longitudinally-extending knife channel 215 is defined withintissue-grasping surface 216 of jaw member 210 at a position offsetrelative to the tissue-treatment area. That is, although knife channel215 is defined within tissue-grasping surface 216, knife channel 215 isoutside the outer bounds of tissue-treating plates 214 a, 214 b. Such aconfiguration is advantageous for use in procedures such astonsillectomy procedures, or other procedures involving the removal oftissue, as bleeding of the tissue to be removed, e.g., tonsil tissue, isnot of concern. In fact, treating tissue that is ultimately to beremoved is unnecessary. Thus, with respect to end effector assembly 200,the advantage of offset knife travel outside the tissue-treatment areais provided, as is the advantage of providing a knife channel disposedwithin the tissue-grasping area, which facilitates controlled knifeadvancement and effective tissue cutting.

Continuing with reference to FIG. 4, the other jaw member, e.g., jawmember 220, defines an insulative jaw housing 222 and an insulativetissue-grasping surface 226. As can be appreciated, upon movement of jawmembers 210, 220 to the approximated position, tissue is grasped betweentissue-grasping surfaces 216, 226 of jaw members 210, 220, respectively.Jaw member 220 further includes a longitudinally-extending knife channel225 defined within tissue-grasping surface 226 that is positioned tooppose knife channel 215 of jaw member 210 when jaw members 210, 220 aredisposed in the approximated position. Thus, in the approximatedposition, knife channels 215, 225 cooperate to define a knife guidethrough which the knife, e.g., knife 262, is translated through uponmovement to the extended position.

In use, end effector assembly 200, with jaw members 210, 220 disposed inthe spaced-apart position, is manipulated into position such that tissueto be treated and cut is disposed between jaw members 210, 220. Withrespect to tonsillectomy procedures, for example, end effector assembly200 is positioned between the cavity wall tissue (or other tissue toremain) and the tonsil tissue (or other tissue to be removed) with knifechannels 215, 225 disposed adjacent the tonsil tissue. Once the desiredposition has been achieved, jaw members 210, 220 are moved to theapproximated position to grasp tissue between tissue-grasping surfaces216, 226. Thereafter, tissue-treating plates 214 a, 214 b may beenergized to different electrical potentials for conducting energybetween plates 214 a, 214 b and through tissue grasped between jawmembers 210, 220 within the tissue-treatment area to treat such tissue.

Once tissue has been treated the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, while maintaining jaw members 210, 220in the approximated position grasping the previously treated tissuetherebetween, knife 262 is advanced through knife channels 215, 225 tocut tissue grasped between tissue-grasping surfaces 216, 226 adjacent(but outside the bounds of) the treated tissue. As a result of thisconfiguration, the wall tissue is treated, while knife 262 separates thetonsil tissue to be removed from the wall tissue adjacent the treatedwall tissue. The separated tonsil tissue may then be removed using endeffector assembly 200, another grasping instrument, a suction device, orvia other suitable method.

Turning to FIG. 5, end effector assembly 300 is similar to end effectorassembly 200 (FIG. 4). Accordingly, for purposes of brevity, only thedifferences therebetween will be described in detail below whilesimilarities will be summarily described or omitted entirely.

End effector assembly 300 includes first and second jaw members 310,320, respectively, each including a respective insulative jaw housing312, 322 defining a tissue-grasping surface 316, 326, respectively. Eachjaw member 310, 320 further includes an electrically-conductivetissue-treating plate 314, 324 recessed or partially-recessed within therespective tissue-grasping surfaces 316, 326 such that tissue-graspingsurfaces 316, 326 define generally planar configurations. Plates 314,324 are adapted to connect to a source of energy. End effector assembly300 may define a bipolar configuration, wherein plate 314 is charged toa first electrical potential and plate 324 is charged to a second,different electrical potential such that an electrical potentialgradient is created for conducting energy between plates 314, 324 andthrough tissue grasped between tissue-grasping surfaces 316, 326 in thetissue-treatment area for treating tissue. In this configuration, incontrast to end effector assembly 200 (FIG. 4), energy is conductedthrough tissue grasped between plates 314, 324 in a generallyperpendicular direction relative to the planes defined by opposedsurfaces 316, 326. However, similar to end effector assembly 200 (FIG.4), the tissue-treatment area is defined between tissue-treating plates314, 324. Thus, energy conduction through tissue is substantiallyconfined to tissue disposed within the peripheral bounds oftissue-treating plates 314, 324 and, accordingly, only such tissue istreated.

Similarly as detailed above with respect to end effector assembly 300(FIG. 4), a longitudinally-extending knife channel 315, 325 is definedwithin the tissue-grasping surface 316, 326 of jaw members 310, 320.Knife channels 315, 325 are disposed in alignment with one another andare positioned outside the outer bounds of the tissue-treatment areadefined between plates 314, 324. In the approximated position of jawmembers 310, 320, knife channels 315, 325 cooperate to define a knifeguide through which the knife, e.g., knife 362, is translated throughupon movement to the extended position. End effector assembly 300 mayinclude any of the additional features and advantages noted above withrespect to end effector assembly 200 (FIG. 4). Likewise, the use of endeffector assembly 300 is similar to that of end effector assembly 200(FIG. 4).

Turning now to FIG. 6, end effector assembly 400 includes first andsecond jaw members 410, 420, respectively, each including a respectiveinsulative jaw housing 412, 422 and an electrically-conductivetissue-treating plate 414, 424 disposed on the opposed surface of therespective jaw housing 412, 422. Plates 414, 424 are adapted to connectto a source of energy. End effector assembly 400 may define a bipolarconfiguration, wherein plate 414 is charged to a first electricalpotential and plate 424 is charged to a second, different electricalpotential such that an electrical potential gradient is created forconducting energy between plates 414, 424 and through tissue graspedtherebetween for treating tissue. Similarly as above, thetissue-treatment area is defined between tissue-treating plates 414,424. Thus, energy conduction through tissue is substantially confined totissue disposed within the peripheral bounds of tissue-treating plates414, 424 and, accordingly, only such tissue is treated.

In order to inhibit energy, e.g., electrical and/or thermal energy, frombeing conducted outside the tissue-treatment area defined betweentissue-treating plates 414, 424 adjacent a first side 402 of endeffector assembly 400, each jaw member 410, 420 includes an insulativedam 416, 426 defining a raised surface 417, 427, respectively. Raisedsurfaces 417, 427 of dams 416, 426 are disposed outside the outerboundaries of the tissue-treatment area and are configured to abut oneanother in the approximated position of jaw members 410, 420. Beinginsulative, dams 416, 426 inhibit the conduction of energy outside ofthe tissue-treatment area on first side 402 of end effector assembly400. Dams 416, 426 may further be configured to set a minimum gapdistance between jaw members 410, 420 in the approximated position. Morespecifically, dams 416, 426 may cooperate to define a total height,e.g., the sum of their respective heights relative to the opposedsurfaces of pates 414, 424, of between about 0.001 inches and about0.010 inches to achieve a similar minimum gap distance between jawmembers 410, 420 in the approximated position.

Continuing with reference to FIG. 6, a longitudinally-extending knifechannel 415, 425 is defined within the jaw body 412, 422 of respectivejaw members 410, 420 at a position offset relative to thetissue-treatment area on second side 404 of end effector assembly 400,e.g., on the opposite side as compared to dams 416, 426. That is,although knife channels 415, 425 are still disposed within thetissue-grasping area defined between jaw members 410, 420, knifechannels 415, 425 are disposed outside the outer bounds oftissue-treating plates 414, 424, e.g., outside the tissue-treatmentarea. Such a configuration provides similar advantages as detailedabove.

In use, end effector assembly 400, with jaw members 410, 420 disposed inthe spaced-apart position, is manipulated into position such that tissueto be treated and cut is disposed between jaw members 410, 420. Withrespect to tonsillectomy procedures, for example, end effector assembly400 is positioned between the cavity wall tissue (or other tissue toremain) and the tonsil tissue (or other tissue to be removed) such thatfirst side 402 of end effector assembly 400 is positioned adjacent thewall tissue, e.g., such that dams 416, 426 are positioned adjacent thewall tissue, and such second side 404 of end effector assembly 400 ispositioned adjacent the tonsil tissue to be removed, e.g., such thatknife channels 415, 425 are positioned adjacent the tonsil tissue to beremoved. Once the desired position has been achieved, jaw members 410,420 are moved to the approximated position to grasp tissue therebetween.Thereafter, tissue-treating plates 414, 424 may be energized todifferent electrical potentials for conducting energy between plates414, 424 and through tissue grasped between jaw members 410, 420 withinthe tissue-treatment area to treat such tissue. As noted above, dams416, 426 help to protect the wall tissue, disposed on first side 402 ofend effector assembly 400, from thermal and/or other energy-relateddamage. Although some heating of tissue adjacent second side 404 of endeffector assembly 400 due to energy escaping the tissue-treatment areamay occur, such an occurrence is not a concern as the tissue on secondside 404 of end effector assembly 400 is ultimately to be removed.

Once tissue has been treated the tissue to be removed, e.g., the tonsiltissue, is separated from the tissue to remain, e.g., the wall tissue.In order to separate the tissue, while maintaining jaw members 410, 420in the approximated position grasping the previously treated tissuetherebetween, knife 462 is advanced through knife channels 415, 425 tocut tissue grasped between jaw members 410, 420 on second side 404 ofend effector assembly 400 adjacent (but outside the bounds of) thetreated tissue. As a result of this configuration, the wall tissuedisposed between jaw members 410, 420 is treated, the wall tissue 410,420 disposed outside jaw members 410, 420 and adjacent first side 402 ofend effector assembly 400 is protected, and the tonsil tissue to beremoved, which is disposed on second side 404 of end effector assembly400, is separated from the wall tissue adjacent the treated wall tissueusing knife 462. The separated tonsil tissue may ultimately be removedusing end effector assembly 400, another grasping instrument, a suctiondevice, or via other suitable method.

Referring to FIG. 7, end effector assembly 500 is similar to endeffector assembly 400 (FIG. 6). Accordingly, for purposes of brevity,only the differences therebetween will be described in detail belowwhile similarities will be summarily described or omitted entirely.

End effector assembly 500 includes first and second jaw members 510,520, respectively, each including a respective insulative jaw housing512, 522 and an electrically-conductive tissue-treating plate 514, 524disposed on the opposed surface of the respective jaw housing 512, 522.Plates 514, 524 are adapted to connect to a source of energy andsimilarly as detailed above with respect to end effector assembly 400(FIG. 6), may define a bipolar configuration for treating tissuedisposed within the tissue-treatment area defined therebetween. Each jawmember 510, 520 further includes a dam 516, 526 defining a raisedsurface 517, 527, respectively, positioned adjacent first side 502 ofend effector assembly 500 outside the tissue-treatment area; and alongitudinally-extending knife channel 515, 525 is defined within therespective jaw body 512, 522 outside the tissue-treatment area on secondside 504 of end effector assembly 500 for receipt of a knife 562therethrough.

End effector assembly 500 differs from end effector assembly 400 (FIG.6) in that tissue-treating plates 514, 524 of jaw members 510, 520,respectively, of end effector assembly 500, in addition to including atissue-contacting portion 519 a, 529 a extending along the respectiveopposed surfaces thereof, each tissue-treating plate 514, 524 furtherincludes an arm 519 b, 529 b extending inwardly towards the respectiveinsulative jaw housing 512, 522 in a generally perpendicular directionrelative to tissue-contacting portions 519 a, 529 a, respectively. Arms519 b, 529 b are positioned adjacent knife channels 515, 525 andextending in generally parallel relation relative to knife channels 515,525.

In use, arms 519 b, 529 b and, more particularly, the generally L-shapedcorner defined at the interface between tissue-contacting portions 519a, 529 a and arms 519 b, 529 b, respectively, create a region ofincreased current concentration adjacent knife channels 515, 525 whenenergy is conducted between plates 514, 524 to treat tissue disposedwithin the tissue-treatment area defined between tissue-contactingportions 519 a, 529 a of plates 514, 524, respectively. This region ofincreased current concentration facilitates the eventual mechanicalcutting of tissue adjacent knife channels 515, 525 using knife 562and/or effects pre-cutting of such tissue while energy is conductedthrough tissue disposed within the tissue-treatment area to treat suchtissue. The configuration and use of end effector assembly 500 mayotherwise be similar to that of end effector assembly 400 (FIG. 6),detailed above.

Turning to FIG. 8, end effector assembly 600 is similar to end effectorassembly 400 (FIG. 6). Accordingly, for purposes of brevity, only thedifferences therebetween will be described in detail below whilesimilarities will be summarily described or omitted entirely.

End effector assembly 600 includes first and second jaw members 610,620, respectively, each including a respective insulative jaw housing612, 622 and an electrically-conductive tissue-treating plate 614, 624disposed on the opposed surface of the respective jaw housing 612, 622.Plates 614, 624 are adapted to connect to a source of energy and,similarly as detailed above with respect to end effector assembly 400(FIG. 6), may define a bipolar configuration for treating tissuedisposed within the tissue-treatment area defined therebetween. Each jawmember 610, 620 further includes a dam 616, 626 defining a raisedsurface 617, 627, respectively, positioned adjacent first side 602 ofend effector assembly 600 outside the tissue-treatment area.

End effector assembly 600 differs from end effector assembly 400 (FIG.6) in that, rather than providing knife channels for reciprocation of aknife therethrough, end effector assembly 600 defines a static cuttingconfiguration. More specifically, one of the jaw members, e.g., jawmember 610, an insulative cutting member 618 extending from jaw body 612towards jaw member 620 on the second side 604 of end effector assembly600, e.g., on the opposite side of plates 614, 624 as dams 616, 626.Cutting member 618 extends longitudinally along jaw member 610 anddefines a generally triangular transverse, cross-sectional configurationhaving an apex edge 619 which may be sharp, although otherconfigurations are also contemplated.

The other jaw member, e.g., jaw member 620, includes an insulativerecess 628 defined within jaw housing 622 thereof and positioned tooppose cutting member 618. Recess 628 extends longitudinally along jawmember 620 and defines a generally triangular transverse,cross-sectional configuration that is complementary to the configurationof cutting member 618 so as to at least partially receive cutting member618 therein upon approximation of jaw members 610, 620. Valley edge 629of recess 628 is defined at the valley of recess 628.

End effector assembly 600 further differs from end effector assembly 400(FIG. 6) in that jaw members 610, 620 each further include anelectrically-conductive cutting plate 662 a, 662 b disposed thereonadjacent second side 604 of end effector assembly 600 such that cuttingmember 618 and recess 628 are disposed between tissue-treating plates614, 624 and respective cutting plates 662 a, 662 b. Cutting plates 662a, 662 b are adapted to connect to a source of energy and, in use, areconfigured to be energized to the same potential as the correspondingtissue-treating plate 614, 624 of the respective jaw member 610, 620.Cutting plates 662 a, 662 b define reduced widths as compared totissue-treating plates 614, 624. Sufficient width for tissue treatmentis not required, as cutting plates 662 a, 662 b are not concerned withtreating tissue disposed therebetween (although some treatment of thetissue disposed therebetween may occur). Rather, cutting plates 662 a,662 b are provided to facilitate creation of an increased currentconcentration region between cutting member 618 and recess 628 suchthat, as detailed below, the increased current concentration, incombination with the high pressure concentration between apex edge 619and valley edge 629 of cutting member 618 and recess 628, respectively,electromechanically cuts tissue disposed therebetween.

In use, with respect to tonsillectomy procedures, for example, endeffector assembly 600 is positioned between the cavity wall tissue (orother tissue to remain) and the tonsil tissue (or other tissue to beremoved) such that first side 602 thereof is disposed adjacent the walltissue and such that cutting member 618 and recess 628 are disposedadjacent the tonsil tissue. Once the desired position has been achieved,jaw members 610, 620 are moved to the approximated position to grasptissue therebetween and tissue-treating plates 614, 624 are energized todifferent electrical potentials for conducting energy therebetween andthrough tissue grasped within the tissue-treatment area defined betweenplates 614, 624 to treat such tissue.

In addition to tissue-treating plates 614, 624 being energized, cuttingplates 662 a, 662 b are likewise energized such that, concomitantly withthe treatment of tissue disposed within the tissue-treatment area,tissue disposed between cutting member 618 and recess 628, due to theincreased current and pressure concentrations therebetween, is cut,thereby separating the tonsil tissue to be removed from the treated walltissue. The separated tonsil tissue may then be removed using endeffector assembly 600, another grasping instrument, a suction device, orvia other suitable method.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon and allow remote operation (or partial remote operation) ofsurgical instrumentation. Various robotic arms, gears, cams, pulleys,electric and mechanical motors, etc. may be employed for this purposeand may be designed with a robotic surgical system to assist the surgeonduring the course of an operation or treatment. Such robotic systems mayinclude remotely steerable systems, automatically flexible surgicalsystems, remotely flexible surgical systems, remotely articulatingsurgical systems, wireless surgical systems, modular or selectivelyconfigurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A method of surgery, comprising: positioning anend effector assembly relative to tissue, the end effector assemblyincluding first and second jaw members, each jaw member having anopposed surface, the opposed surfaces defining a grasping areatherebetween, the end effector assembly further including atissue-treating plate disposed on each of the jaw members, thetissue-treating plates defining a tissue-treating area therebetween,each of the jaw members defining a knife channel positioned within thegrasping area and outside of the tissue-treating area, wherein the endeffector assembly is positioned relative to tissue such that the knifechannels are positioned adjacent tissue to be removed; moving at leastone of the jaw members relative to the other from a spaced-apartposition to an approximated position to grasp tissue therebetween;energizing the first and second tissue-treating plates for conductingenergy through tissue disposed within the tissue-treating area to treattissue disposed within the tissue-treating area; and advancing a knifeat least partially through the knife channels to cut tissue adjacent thetissue-treating area, thereby separating tissue.
 2. The method accordingto claim 1, further including removing the separated tissue.
 3. Themethod according to claim 1, wherein conducting energy through tissuedisposed within the tissue-treating area includes conducting energy in agenerally parallel orientation relative to the opposed surfaces of thefirst and second jaw members.
 4. The method according to claim 1,wherein conducting energy through tissue disposed within thetissue-treating area includes conducting energy in a generallyperpendicular orientation relative to the opposed surfaces of the firstand second jaw members.
 5. The method according to claim 1, wherein atleast one of the jaw members includes a dam positioned outside thetissue-treating area on an opposite side thereof relative to the knifechannels, wherein positioning the end effector assembly includespositioning the dam adjacent tissue to remain, and wherein, during theconducting of energy between the tissue-treating plates, the daminhibits energy from being conducted outside the tissue-treating areatowards tissue to remain.
 6. A method of surgery, comprising:positioning an end effector assembly relative to tissue such that tissueis disposed between first and second jaw members of the end effectorassembly, the first and second jaw members having opposed surfaces thatdefine a tissue-grasping area therebetween and a tissue-treating areatherebetween, the tissue-treating area disposed within thetissue-grasping area; moving at least one of the jaw members relative tothe other from a spaced-apart position to an approximated position tograsp tissue within the tissue-grasping area; energizing at least one ofthe jaw members for conducting energy through tissue disposed within thetissue-treating area to treat issue disposed within the tissue-treatingarea; and advancing a knife at least partially through tissue graspedwithin the tissue-grasping but outside the tissue-treating area to cuttissue adjacent the tissue-treating area thereby separating tissue. 7.The method according to claim 6, further including removing theseparated tissue.
 8. The method according to claim 6, wherein conductingenergy through tissue disposed within the tissue-treating area includesconducting energy in a generally parallel orientation relative to theopposed surfaces of the first and second jaw members.
 9. The methodaccording to claim 6, wherein conducting energy through tissue disposedwithin the tissue-treating area includes conducting energy in agenerally perpendicular orientation relative to the opposed surfaces ofthe first and second jaw members.
 10. The method according to claim 6,wherein at least one of the jaw members includes a dam positionedoutside the tissue-treating area, wherein positioning the end effectorassembly includes positioning the dam adjacent tissue to remain, andwherein, during the conduction of energy through tissue disposed withinthe tissue-treating area, the dam inhibits energy from being conductedoutside the tissue-treating area towards tissue to remain.